Study of Awareness, Acceptance and Continuation Rates of Depot Medroxyprogesterone Acetate as Post-abortion Contraception

Introduction:Contraception is essential for empowering women and managing population growth in India.Injectable depot medroxyprogesterone acetate (DMPA) offers long-acting, reversible contraception with 3 months of protection per injection.This study evaluates the awareness of contraceptive methods among post-abortal women and examines the acceptance and continuation rates of DMPA in this group.Materials and methods: A prospective, longitudinal intervention study was conducted in the Department of Obstetrics and Gynecology, at a tertiary care medical college and research institute from November 2017 to May 2019.All women who were admitted for any type of abortion, induced or spontaneous (incomplete/inevitable/septic) abortion, except threatened abortion, were subjects for the study of contraceptive awareness.Women who opted for the DMPA as a post-abortion contraceptive choice were included in studying acceptance and continuation of the DMPA method.Results: Most of the women (95%) in the present study were from the reproductive age-group of 18-35 years.The majority of women were multiparous (55.34%), while 35.34% of them were primiparous.Among the 300 women counselled for DMPA injection, 221 women accepted and gave consent.Most of them had awareness of surgical sterilization, natural methods, and condoms and low awareness of DMPA (17%).73.67% of 300 women accepted DMPA, with 66.6% being "very satisfied" with the method.The continuation rate after the third injection was 58.78%.The most common side effect was irregular bleeding (59.72%), followed by amenorrhea (34.38%); 99% experienced menstrual cycle changes.Medroxyprogesterone acetate was safely administered to women with hypertension, diabetes and women on antitubercular treatment and antiretroviral therapy.No pregnancies among the 1,764 women cycles of exposure, resulting in 100% efficacy. Conclusion:Injectable DMPA is a highly acceptable contraceptive with 100% efficacy and no pregnancies in 1,764 women cycles.The main side effect was menstrual irregularities, which led to some discontinuations, but pre-use counseling improved acceptance.Medroxyprogesterone acetate is a suitable long-acting reversible contraceptive in the post-abortal period, with high acceptance and continuation rates.Clinical significance: Post-abortion contraception is vital in spacing the next pregnancies and avoiding unwanted pregnancies.Injectable DMPA as a post-abortal contraception has good acceptance and continuation rates when method-specific counseling is done.